Jim Wells
South Down · Democratic Unionist Party · Northern Ireland
“On a point of order, Mr Deputy Speaker. In November 1982, I made my maiden speech in the Chamber, and, here we are, 40 years later, and I am making my last speech in the Chamber as a DUP MLA. I was the last person in the Public Gallery when the Assembly collapsed in 1976.”
“<BR /> <BR />Mr Deputy Speaker, I thank you for your indulgence and for your patience with me over many years. Unfortunately, Mr McGlone has just left the Chamber; I was about to thank him. I have enjoyed my 27 and a half years in this Building.”
“I wish that I could, but I have only five minutes. <BR /> <BR />That was so that a very small number of Irish language zealots could go in and register their marriage or civil partnership in Irish or in dual language: £261,000. Did anybody stop to think about whether there was a more cost-effective way of doing that?”
“We are all perfectly happy with a genuine expression of people's culture. That is fine. However, when the language is so cynically used by militant republicanism, unionism has difficulties. Why, for instance, is there no translation into Irish of the words, "United Kingdom", "Londonderry", "Northern Ireland" or "Her Majesty The Queen"?”
“The Member has made the point for me. The official who came to the Committee made it absolutely clear that £261,000 had been spent already. It was farcical to bring that before either the Finance Committee or the Assembly, because the money had been spent and the processes had been set up.”
“If they want the unionist community to accept the Irish language as a genuine cultural expression, they should get rid of the political baggage and extremism, and stop using the Irish language as a political weapon to try to subjugate unionism.”
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“We have to decide whether our community is ready for this. Will they buy into it? Will they buy into it on the basis that they know that every penny that they put into the till will go towards much-needed treatment for their friends, relatives and, maybe, ultimately, for them?”
“Various models are being postulated. It could be £6 million; it could be £9 million. If I wanted to introduce all the additional services or drugs, including the vaccine that the honourable Member mentioned, it could be up to £24 million or £25 million, but it is a matter for public consultation. The options will be clearly set out, and option 1 will be to do nothing. I will be very interested to hear what the public say on the "do nothing" option, which would mean staying as we are but with no funding for these much-needed treatments. <BR /> <BR />I welcome the Member's very positive engagement and detect that all Members are at least keeping an open mind. I understand entirely where the Chair of the Health Committee is coming from — I do — and, if I were her, I would be raising the very same points.”
“I am glad that the Minister of Finance is here with me because I will make absolutely certain that this is additional money. I am certain that the Minister of Finance, even in his darkest hour, would never dream of saying, "The health service is introducing a scheme. The public will take the pain of the small charge and raise £10 million. Therefore, I will reduce the health budget by £10 million to compensate for that". I know that the honourable Member for Strangford is a man of honour and integrity. He would never dream of such a thing, but I remember that additionality was a problem in European funding. This will be extra money, and it will be hypothecated — I was dying for a chance to use that word — in order to secure additional funding. <BR /> <BR />The Member asked about the amount of money needed.”
“I have my doubts about whether all of them were in that position. The figures from his constituency were quite remarkable. I am not convinced that over 80% of the people living in North Down were consistently in a position in which they could not afford prescriptions.”
“<BR /> <BR />Equally, once you get into means-testing and the situation where you ask people whether they have the income to pay, previous evidence shows that, unfortunately, the vast majority of people prefer not to pay. What worries me is that people had the opportunity to be open and honest under the old scheme, and, in many communities, the vast majority chose to say that they could not pay for prescriptions.”
“We are talking about maybe 50p or £1. We are not talking about going back to the model of £6·40 or, as in GB, over £8. Certainly, in the consultation, I will be interested to hear whether anyone suggests a voluntary approach. The problem is this: what degree of certainty can you achieve with a voluntary approach? We know what we need to meet the demand for these drugs. We will model how that need can be dealt with, given the fact that we have very clear knowledge of the present demand for prescriptions. The problem is that you could end up committing yourself to very substantial expenditure on much-needed drugs and find that the voluntary income comes nowhere near what one would expect or need. Whilst initially it is attractive, I do not see it being realistic.”
“I know how the House would react if we tried, by stealth, to use it as simply a fundraising device for health generally.”
“I do not know who will be Minister by the time this is all up and running, but, for as long as I am there, I certainly will not be using it as a way of funding other aspects of health service budgets. We are certainly not going to use it to plug any black holes, of which there are many, in the health service budgets. It will be very clearly ring-fenced for this purpose. It has to rise, but it will rise because demand for these essential drugs and treatments is rising. It is not rising because we are using it as a way of finding money for other things. In addition to the cancer drugs, other treatments are coming online, which are expensive. I would like to be able to offer people the prospect of those new services as well; for example, vaccines. That is my commitment.”
“In the consultation, a number of options will be set out for prescription charges and the potential exemptions; in other words, the fee. We are finalising those models, and it is not possible at the moment to give any further detail. <BR /> <BR />I am very aware that this could be seen as a tax by stealth, which we would gradually crank up. We will have total transparency around how this is operated. Members will know what is needed and what we are doing with it. Of course, the Committee will be consulted regularly as to how it is operating. Even if we did not do that, I know that the present Chair would be constantly badgering us about it anyhow.”
“That is the third question that I predicted was going to arise. <BR /> <BR />We have a specific idea of the sort of funding that we need to meet demand. We are working on various models as to how we achieve that. We will definitely not be going down the route of means-testing, I can assure him of that. That would negate the whole issue. Let us be honest: it is quite clear that, under the old scheme, people were getting free prescriptions who were not entitled to them. We have to accept that. If you are the local pharmacist in a community and are faced with someone you have known all your life saying, "I'm entitled", in what position is the pharmacist to contradict that? It is very difficult for the customer/pharmacist relationship.”
“People need to get their heads around the fact that there will be people in Northern Ireland who will be paying that small charge for the first time ever. That is understandable. <BR /> <BR />There is a second issue in that, since the abolition of prescription charges, the numerical demand for prescriptions has risen very significantly. If you put some value on a prescription, albeit quite a small value, people will stop and think whether they really need it and whether they should be demanding it for free when they can buy it across the counter. That aspect is a very minor consideration in the overall scheme. We are trying to purchase essential drugs, not save on demand.”
“<BR /> <BR />When I was quite ill, just before the end of the prescription-charging regime, I was asked whether I got free prescriptions. I thought that that was a pretty silly question, but I was invited to sign the back of the form — not that I did. I thought to myself that, if I signed the back of the form and was not entitled to do so, what would the chances be of getting caught. We were spending £2·5 million a year trying to police that, and one of the reasons why I supported Mr McGimpsey when he abolished prescription charges was that I did not see it as an efficient model, as we were spending so much money policing it. <BR /> <BR />The good thing about a small blanket charge is that there are no problems with enforceability or fraud, because everybody will pay it.”
“That would eliminate a huge amount of administration. I am sure that that is too simple and that there would be resultant issues. I have spoken to pharmacists about the concept and their overall view of it, and there is general support for it. We do not want a model that will eat up vast amounts of money in administration. <BR /> <BR />The Member is absolutely right about the old prescription charge. We had communities in Northern Ireland in which 90% of those who walked through the door of the pharmacy got free prescriptions. I find that very hard to believe. That happened even in areas in the Member's constituency, like Carrickfergus, which is not an area of rural poverty and where there are high rates of employment. It always amazed me that practically everybody got free prescriptions.”
“I thought that that point would have been raised in the second or third question today. As we are guaranteeing total transparency, people will know exactly what is coming in and what is going out. If we are successful, I want to be able to stand here in a year's time and show Members that, if we have brought in £20 million, we were spending £19·5 million or whatever on specific cancer drugs and other drugs. That is why that commitment, which I will also make to the Committee, is so essential. The Member will be able to see the costs. <BR /> <BR />One interesting model has been suggested, although none of this is concrete. At the moment, we pay pharmacists a small administration charge of about a £1 for every drug that they dispense. One idea is to stop paying that and simply collect the £1 and put it into the kitty.”
“With the sort of money that is coming down the pipeline for what can be assigned to a particular patient for a specific condition, we will have to develop a model that will mean that we can answer that demand on a long-term basis. Some of those drugs are incredibly effective, but the prices are, quite honestly, frightening, so we need a long-term, sustainable model that we can use to pay for them. I cannot see the health service being in a position, in the foreseeable future, to meet that increasing demand. I know that the Member's constituents in East Antrim will be lobbying him intensely when those drugs become available.”
“People regularly write to me and say, "Why don't you address this issue?" and, "Why, when I go into the pharmacy, am I not expected to make a small contribution?" Remember that the pound comes nowhere near the cost of the prescription; it is only a tiny fraction of its value. We were paying £6·40 before the end of prescription charges. In England, they pay over £8·00. A season ticket in England costs over £100. Ours will be significantly different. We continue to press on inefficiencies, and it is a long-term situation. <BR /> <BR />I have seen some of the figures that have been quoted for bespoke designer drugs for specific patients.”
“<BR /> <BR />My wife is on four or five prescriptions a day, and I am sure that that is running into thousands of pounds per year. Obviously, I could pay the £25, but what I want to hear from the community generally is whether that is acceptable. If we drop it to £15, the fund will be smaller for vital drugs. The difficulty is in getting a model that produces the income in a way that is sustainable in the community. From the various views I have received, a figure of £25 could be seen as a sensible compromise for people who could not possibly afford to pay £1 every time they went into the pharmacist because it would cause real poverty. <BR /> <BR />That is why the consultation will be so important. What do the public really think about that suggestion? Generally speaking, I find a lot of support in the community.”
“That is a very valid point. First, we are imposing very stringent savings on the budget for 2015-16 to try to deal with those issues. Like everyone else, I am determined to drive down the cost of prescriptions; and we have been successful in the move to generic medicines. <BR /> <BR />He made the point that I expected to be made at the very start of this debate on the £25 or £20. The consultation, which will be open to all of the public, will have several options, including the "do nothing" option, which would mean that we stay as we are. Various models will be set out, and one of them includes the figure of £25. We want to set it at a figure that is affordable to our community. For most people, £25 for an entire year's supply of drugs, the value of which could be running into tens of thousands of pounds worth of value, is welcome.”
“If a case is red-flagged — if it is put forward by the oncologist as an urgent case — we will endeavour to see that person within two weeks. I am very interested in the case the Member raised, and I ask him to write to me and quote the difficulties. I am very keen to see why that person has been waiting six months and is looking at the option of private treatment. I would like to check with Western Trust officials and the City Hospital's cancer centre to see why that is happening, because something just is not right about the difficult dilemma his constituent is in. If the Member writes to me, or even emails me today, we will turn that round as quickly as we can.”
“That would be an unusual case. It is mostly orthopaedic surgery that is carried out in the private sector. He, from the Western Trust area, can at least tell his constituents that in 2016 there will be a state-of-the-art £66 million facility at Altnagelvin in Londonderry, which will be co-funded by our colleagues in the Irish Republic and will mean that the capacity problems that we have at the City Hospital are somewhat relieved. <BR /> <BR />That is a commitment that I have made, and Edwin Poots also made it. Others said it could not be done, but the Member will no doubt be invited to the ribbon-cutting of that much-needed facility in a year's time. That offers hope for his constituents in Omagh and Strabane that there is extra capacity. <BR /> <BR />In the meantime, we are working as hard as we can to relieve the waiting list.”
“Four have faced it already, but there could be another 50. That is where we are going with this disease.”
“What we simply do not have in that context is the extra £6 million to £9 million required to fund cancer and other drugs on top of the £12 million that we have to find for the NICE-approved drugs. <BR /> <BR />We are coming through a very difficult phase. I know that Members will say, "Well, what's different now from the decision made by Mr McGimpsey six or seven years ago?" Since then, we have moved on to a totally different financial planet for health in Northern Ireland, and that is the problem. Demand is rising inexorably. When you consider that there has been a 43% increase in referrals for cancer diagnosis since 2009, that gives you an indication of the speed with which this condition is growing in Northern Ireland. One in two means that 54 people in this Chamber will face cancer. That is how frightening it is.”
“Please do not hold me to that because that model has to be refined significantly. That, of course, depends upon at what level the committees agree to funding. It could be up to the higher end. <BR /> <BR />That is on top of all the other pressures that we are facing in Northern Ireland in health. Unfortunately, there are some difficult decisions to be made in terms of finding the £50 million in savings in the non-health trust element of the budget — that is, the Fire and Rescue Service, the PHA, the BSO etc — and the £165 million in efficiency savings that have to be found within the six trusts. I can tell you that there is some burning of the midnight oil going on within the Department as we work out how to do that.”
“No. We envisage that the cost of running the committees would be relatively small in the overall scheme of things. Remember that we are already spending. For instance, last year we spent £1·5 million on 170 individual funding requests. It is difficult to separate out the cost of the additional expenditure on drugs from the cost of the committees, but I do not see them being a large component of the overall cost. <BR /> <BR />Going by the Barnett formula as a guide, if we were to implement the cancer drugs fund on the same ratio as the rest of the United Kingdom, it would be between £6 million and £10 million. Our model is being considered specifically for Northern Ireland and is not directly comparable, but we expect the extra cost in drugs to be between £4·8 million and £9·5 million, roughly.”
“Oncologists will be an important component because 66% of IFR applications are the result of cancer diagnosis. One committee will be dedicated to oncology and one to other conditions. These are the people at the coalface; experienced clinicians who are European leaders in the treatment of cancer and who will be making the decisions. I would put my trust in them because the evidence would indicate that the cancer centre, particularly under the management of Paddy Johnston and his team, was producing first-rate results for people in terribly difficult circumstances.”
“I can absolutely guarantee that this is not going to be a committee made up of administrators or bureaucrats. This will be a committee largely of experts in the field, the oncologists who know what they are talking about and whether a drug treatment or new form of treatment will lead to a real improvement in the condition of the patient. <BR /> <BR />Sadly, most of these drugs are not life-preserving; they are life-enhancing and increase life expectancy. There are very few treatments that we can say lead to a cure, although Allister Murphy from east Antrim, who came to see me to lobby on this issue, made the point that sometimes that can extend the life of a patient to the point when another drug becomes available. Therefore, it can, on occasion, offer hope. <BR /> <BR />The committees will be made up of leading clinicians.”
“I thank Mr Spratt for his question and pay tribute to Mr Spratt, Ms Bradley, Mr McMullan, Seán Rogers and others in the Assembly who have gone through that journey of a cancer diagnosis and who have been courageous enough to come forward and make their views known in the Assembly about their personal circumstances. We have all learned a lot from listening to their experiences, and that has been helpful in the improvement of services.”
“I want a system that allows me to look patients straight in the eye and say that we have a lean, fast and efficient system that will give you a decision quickly on your clinician's IFR referral. I will be watching this very carefully to make certain that bureaucracy is kept to a minimum and that we ensure that we can offer hope to these people, who are often at a terribly low stage in their lives.”
“Initially, there is going to be a surge in applications if we go into this model. The committees will meet weekly, which will certainly help the situation, and it will be a much more efficient system. It will also ensure that there is equal access to drugs throughout Northern Ireland, so we will have some consistency. Do not be surprised if the numbers of IFR referrals rise quite significantly in the first few months; that is good news, because that means that clinicians feel that, under what we are suggesting, there is a much more realistic chance of getting the drugs made available and paid for. We will watch that very carefully. <BR /> <BR />I find this issue very difficult personally, because some of the people whom I have dealt with have passed on even in my short time as Health Minister.”
“The benefit of those new committees is that they will not be bound by the 95% threshold which, we all agree, is so ridiculously high that very few people can avail themselves of it. We will be asking these committees, which will be made up of experts in the field, to move quickly on applications, examine them very carefully and be transparent. Part of the problem at the moment is that many patients are left without any detailed knowledge of why their IFR application was not made. <BR /> <BR />I also need to emphasise that inherent in what we are doing is that many clinicians who, up to now, have felt it was not worthwhile applying because of the 95% exceptionality criteria will now feel that it is well worth their effort in going through the paperwork to apply.”
“I understand that, at the moment, we are spending about £1·9 million a year on these specialist, non-NICE-approved drugs. Our model suggests that that could treble or quadruple under the proposals that I am making this morning. That is a genuine commitment to many people, but there will still be patients in Northern Ireland to whom the committees, after they have looked at the applications, will say no. There will still be situations where the assessment will be either that the drug is not effective or it is not cost-effective. There will still be difficult decisions to make, but much fewer than today.”
“That indicates the enormous stress that it is under. English authorities are having a rapid review of how they are doing things to make it more sustainable. <BR /> <BR />We have looked at models in Wales and Scotland. I like to think that what we are proposing takes extracts from all the models to try to bring some form of sustainable model to Northern Ireland. When we go out to consultation on this, if folk feel like we have got it wrong, by all means, please let us know. We are trying to find a system that offers hope to many hundreds of people in Northern Ireland but does not lead to an unsustainable model where we are going to end up having to close the fund because it is running out of control. We feel that we have a fine balance between the various models.”
“We spend £600 million a year on drugs in Northern Ireland, and we spend £27 million on specialist cancer drugs already. I do not want people thinking that we are not already committed to that field. All NICE-approved cancer drugs will be made available to people in Northern Ireland. <BR /> <BR />The English CDF was established at £200 million a year. There has been a growing consensus throughout England — it was echoed by many of the respondents to the consultation on the individual funding requests (IFR) review — that it is only a short-term fix to a complex problem. It is not sustainable or equitable because it deals only with cancer patients; it does not give hope to those with other conditions. In 2014, it went over budget by £140 million. That is on the basis of a £200 million budget.”
“I welcome his support for some form of additional charge for prescriptions. I want the Health Committee and the Assembly to debate the issue and to come to a thought-out view on it. At the end of the day, I am going to need that support because the system that we have here in the Assembly means that things can be stopped very quickly if they do not have cross-party support.”
“I made the point that we are already committed to spending £12 million in increased budget for pharmacy simply to take cognisance of decisions that NICE in London made. So, we are not yet in a position to be definitive, but it is pretty clear that we are running fast to keep still. That will not provide us with the additional money that we need to do what we should, which is to offer hope to many cancer patients and other patients. Keep remembering that this is beyond cancer. Other life-threatening conditions in Northern Ireland also require those specialist treatments. I know that he has written to me on several occasions on behalf of his constituents on these issues, as has almost every Member and every MP. <BR /> <BR />The sums clearly indicate to me that the PPRS is useful, but it is not going to meet our ultimate need.”
“Mr McCallister's question for written answer is dated 18 February, so it is literally hot off the press. No doubt he will use that against me in the local press and say that he was on the ball. <BR /> <BR />We need to understand that PPRS is based on a refund to the Department based on receipts of drug expenditure undertaken. Therefore, to some extent, it is difficult to predict exactly how much is going to come in. It always comes in retrospectively. We introduced the PPRS in Northern Ireland only on 1 January 2014, so whilst we very much welcome it, it is still in its infancy. The Member needs to understand that that income, which, according to the answer given to Mr McCallister, could be £12 million or £13 million, is in the context of £165 million that I need to find to deal with financial pressures in 2015-16.”
“I made the very important point in answer to one of my first questions in the Assembly — from Mr Brady in 2014 — that, for the first time ever in Northern Ireland, more people who have been diagnosed with cancer will be alive in 10 years than will have passed away. There was also a very useful question from Mr McKinney, which is in the system, asking for an outline of where those improvements have occurred. For some conditions, like childhood leukaemia and prostate cancer, the outcomes are extremely good in Northern Ireland. However, we have a long way to go, and I need a mechanism to raise additional resources to continue that improvement.”
“That is the benefit of concentrating resources in the Belfast cancer centre at the City Hospital site, where all the experts on the conditions come together to give the best possible treatment. We are working hard and trying our best to get back to the target of 95%. Again, however, this emphasises the need for additional resources for cancer treatment. <BR /> <BR />If some of those drugs were available, it may be that the outcomes for patients in life enhancement would be better. That would put more pressure on the system, because if people live longer, they have to be treated for longer.”
“First, I pay tribute to Mr Coburn. I watched the programme on BBC 1 about cancer at 3 o'clock in the morning in the Royal on my iPad as I was sitting with my wife. I was taken by his comments, which were very legitimate. Mr Coburn had, of course, made an outstanding contribution to the economic life of Upper Bann. <BR /> <BR />We face huge pressures on cancer referrals at the moment; I accept that. We get periods when we do not meet the target. That is caused, on this occasion, by an increase of 8,500 people per year getting the bad news about their condition. I am somewhat relieved to hear that, despite that pressure, our outcomes for many forms of cancer are excellent by UK standards.”
“This is a standard tariff for every man, woman and child in Northern Ireland, with a ceiling for the year of an unspecified figure, which, we hope, is affordable to the entire community.”
“We have set the pharmaceutical budget a very stringent target of £20 million of savings next year, and that will be the tool that we will use to eliminate any perceived wastage. <BR /> <BR />I can say to him that that aspect of our budget has become more and more efficient. When I was Chair of the Health Committee, we spent £400 million a year on community pharmacy. That is now down to £362 million, largely because of a decrease in wastage, but also a greater uptake of generics. I want to satisfy him that we are dealing with this before I would expect him to agree to what we are proposing. This is a different model; this is not going back to prescription charges of £6·40 per script or £8 in England.”
“While all this is going on, NICE is still adjudicating on a series of new treatments. Once NICE agrees with that at a GB level, we are then in a position where we have to implement those treatments. Therefore, the money has been swallowed up. Whilst we welcome the PPRS — it is good news, and I am very happy that ABPI has agreed to it — the reality is that it does not provide us with the new money that we need. <BR /> <BR />He also raises the issue of wastage, which is a very valid point. Having listened to him talk about that issue in the media, I know that he feels that, at the moment, he is not in a position to sign up to any administrative charges for prescriptions if there is still perceived wastage.”
“If I was sitting in his chair, I would be asking those exact questions. I am indebted to MLA John McCallister, who asked a question on that subject very recently, albeit that the answer may not yet be available on the website, and so I can answer Mr McKinney's first point specifically. He asked me to outline the quarterly income from the PPRS to the health service budget. In quarter 1, which is from January to March, it was £3·53 million. In quarter 2, it was £3·83 million. These are all 2014 figures. In quarter 3, it was £3·92 million. It does not take a mathematical genius to add that up; I can do it. If you extrapolate that, you are talking about over £12 million. That has been entirely eaten up by the extra £12 million that we have committed to spend to deal with the increase in NICE-licensed and agreed drugs.”
“<BR /> <BR />Last year, we spent an extra £12 million simply funding the NICE-approved drugs that became available automatically. That has eaten up any PPRS income almost entirely. Therefore, we need a fresh source of income so that we can offer hope to those very needy people. I do not want to sit in my room any longer and say to folk that, because of our restrictions and the 95% exceptionality test, we cannot offer them any possible outcome.”
“More will be spent on those specialist treatments in Northern Ireland, but we cannot have the situation of an open-ended chequebook that has occurred in England, which has run out of control. It still has to have some form of exceptionality test. I will give you an example. I dealt with two drugs yesterday, which I will not name. One of them costs £220,000 per year per patient for four people in Northern Ireland, and the other one costs £252,000 per patient in Northern Ireland. That is the sort of money that we are talking about. Those drugs are often what are called orphan drugs. The costs of development are spread over such a small number of patients that the cost is incredibly high. That is unfortunately where we are moving and is why we need the extra money to fund them.”
“If they are handing their 30p, 50p or whatever across the counter, they will want to know that it is being used to help people in need. <BR /> <BR />One of the most painful experiences that I have had as Health Minister was sitting across the table from Una Crudden on several occasions and her making an impassioned plea for a drug that would help those with ovarian cancer and extend their life. The present system means that we were unable to offer people such as Una hope. I hope and pray that, as a result of the changes, we will be able to look at those people and say that, provided that the local committees are happy that it is an effective treatment being provided, we can offer them that hope. Implicit in what we are doing here is a significant increase in expenditure on specialist medicines. That is why we need the extra money.”
“That is a very important question. Members will not agree to anything that simply fills a black hole in some other part of the health service budget. What we are committing ourselves to is to using the money to help establish the specialist medicines fund to support approved and unapproved medicines. I can guarantee that the additional funding will allow HSC to improve access to unapproved drugs, but some of it may also be required to meet pressures in approved drugs. I will commit myself here to openness and transparency on that. We are more than happy to allow the Health Committee, the cancer charities, and so on, sight of exactly what is coming in and where it is being spent. There has to be absolute openness and transparency, because we are going to ask people to make a small contribution for their prescriptions.”
“Again, we are working on those models. I certainly want to keep cost down to an absolute minimum.”
“In the proposed situation, it would not be a case of having to check prescriptions to see whether a person was entitled to free prescriptions. It would be relatively easy to scrutinise because everyone would be paying. <BR /> <BR />We have been driving up the rate of our use of generic drugs. I think that the last time that I looked at it, it was at 72%. It is still 72%. Each one percentage point rise saves us £6 million a year. Of course, the difficulty is that we have picked the low-hanging fruit. The result is that it is more and more difficult to increase the level of use, but I certainly want to see that work continue. For instance, the cost of the administration of prescription charges under the old model was £2·5 million a year. That was a drain on resources. We have here an initial set-up cost and administrative costs.”
“In GB, in England, at the moment, the cost is £26 a quarter. Many people have told me that they would welcome the chance to make some contribution to health-care provision. They feel that it is unfair that people are getting prescriptions entirely for free. <BR /> <BR />The Chairperson makes a very valid point about wastage. As she knows, the permanent secretary is looking at administrative wastage in the service, with a view to taking out significant savings. I see the administration of what is being proposed costing several hundred thousand pounds rather than several million pounds. There will definitely be costs associated with it. We found that, when we had prescription charges under the old model, we were spending a very large amount of money on enforcement and scrutiny. That was not a good use of resources.”